mercredi 4 février 2009

What if The Brain is winning?

A reader asks in comments: what if The Brain is stronger than the Dog Training Voice?

Well, it might be just that you need more practice. CBT is like anything else, you get better at it with practice. In the beginning, The Brain is used to having its own way all the time, and the Dog Training Voice has never tried to tame a rogue brain, so it's not a fair fight. But with time and persistence, the Dog Training Voice becomes stronger and more wily. It's on to The Brain's tricks. And it starts to win.

One time last summer, for some reason The Brain got triggered when I picked up a jumbo crochet hook. And I had been having one meltdown after another for weeks and weeks, and I was really tired of them. Tired as in fatigued. So when The Brain started up, one of the other "voices" of me came unglued on him and just screamed that there was NOT going to be a meltdown, period. And The Brain backed down. That marked a turning point in the fight against The Brain. The balance of power changed, if you will. It's changed the form meltdowns take and made them a lot less frequent. So, a CT victory. But it took a long time to get there.

That being said, and I've said it before, CBT does not cure things. If you have a organic issue of some kind, CBT will not make it go away. So, if the Dog Training Voice continues to be unable to control The Brain, or if controlling The Brain doesn't solve everything, then you might want to get professional help. For example, when I got pretty good at CT, I came to a point where I had no cognitions whatsoever. Most of the time I'd just go around either doing my job, or playing circus music in my head. But at the same time, I couldn't stop crying. I would cry for days and days and days. Literally. I didn't have any cognitions, so there was nothing to work on to make me stop crying. So, what's to do? That's when I went back on medication. It worked like magic. Practically overnight, I didn't cry anymore. I didn't have to spend every ounce of mental energy "keeping it together." I still have cognitions and meltdowns, but not the out-of-control emotions. It sure makes my life considerably better.

So, if you can't control The Brain with CBT, or if controlling The Brain doesn't solve the problem, like I said, you might want professional help. And the kind of help you need depends on what's exactly wrong with you, so I can't really say, but here are some generalities.

If The Brain is a danger to yourself or others and won't be controlled, it's a good idea to go to the nearest hospital. If you tell the triage nurse that you're a danger to yourself or others, it's awkward, but it makes you a fairly high triage priority. If you have no hospital or you don't wanna go there, find someone to babysit you until you can see a doctor. It's called a suicide watch, and you need it to live. If you're in a remote community, they should medevac you, because you're a genuine medical emergency, but having not tried it, I have no idea whether they will or not. So if that's your predicament, you might have to fight with them about it. Sucks, but you do need medical help.

If The Brain is not a danger to yourself or others, but you're having a meltdown or that state of things where the cognitions eat at you like a big rat sitting in your skull gnawing on your brain, I find the best policy is to go to sleep, if you can. If you can't, again, I find it useful to find someone to babysit. The best, in my opinion, is to call a good Crisis Line, because the people there will listen to you without judging your cognitions like your friends will (and your friends will judge your cognitions, because they're not trained to deal with the mentally ill). Some times talking about the cognitions out loud helps break the cycle of rumination, or maybe it's just that after an hour crying on the phone you're ready to fall asleep. Doesn't matter, as long as you can go to sleep. When you wake up, hopefully you'll feel better. But then again, maybe not, so you might want to see a doctor. Apparently, they have medication for that.

If you have a genuine organic mental illness, like bipolar or schizophrenia, you will not control it through CBT alone. You will need medication, and probably you will need to be medicated for the rest of your life. Anti-psychotic drugs, from what I've read, have unpleasant side-effects, but mood stabilizers are fairly easy to tolerate. You might have to keep changing drugs until you find one that works and doesn't have side-effects you can't live with.

If your issues come from trauma, you need specific strategies for coping. If you go to a professional and you feel that they're not listening to you or that they're not addressing the right problem, find a different one. A bad therapist is worse than no therapist at all, in my experience.

If your issues come from grief, again, you need specific strategies. With both grief and trauma, they might heal over time, or they might not. As I mentioned before (though I'm not sure if it was on this blog), in my case I feel like a limb has been ripped off, and I can learn to function with the new state of things, but I can't be made whole. Recently I've found other people who express their feelings the same way, which was nice. Makes me feel validated. If you're in a similar position you might not ever get back to "normal". What you have now is the new "normal" and you have to learn to function with it.

So, that's what I have to say about it. Thank you for your question. I hope this helps.